With the availability of surfactant, high frequency oscillation and extracorporeal membrane oxygenation, concerns have been raised that death has been excessively prolonged for some infants in the newborn intensive care(NICU) setting. To test this hypothesis, we did a retrospective chart review of the time course and circumstances surrounding death for two cohorts of infants cared for in our level III NICU. Infants in Group 1 (N=127) died between 7/1/85-6/30/88 which immediately preceded the availability of surfactant for investigational use in our NICU. Infants in Group 2 (N=75) died between 7/1/91-6/30/94 in the three years immediately following the licensure of exogenous surfactant. Characteristics of the two groups follow: Table

Table 1 No caption available.
Full size table

Fewer than 30% of infants in either cohort had more than 1 episode of cardiopulmonary resuscitation (CPR). Only 30% of infants in either group survived for more than 12 hours post-CPR. While in Group 1, discussions of discontinuation of support were almost always (98%) initiated by physicians, in Group 2, 28% of discussions were initiated by nurses or parents. Since most deaths still occurred within one week, we conclude that the availability of newer technologies has not resulted in additional prolongation of death. The increased numbers of infants who had discontinuation of support at the time of death in Group 2 suggests that physicians are increasingly willing to individualize such decisions despite availability of advanced technologies.